1990-169 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date April 26 19 90
This is to certify that work requested to be done as shown by Permit No. 90-169
has been completed.
This structure may be occupied as a sewave alteration
Location 22 Bonner Drive
Owner David Bolster
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 90-169 0
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to David Bolster
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OWNER of property located at 22 Bonner Drive . Street, Road or Ave.
in the Town of Queensbury,To Construct or place a sewage alteration
at the above location in accordance to application together with plot plans and other information hereto filed and N.
• approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. -
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1. OWNER'S Address is C/)
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2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
PO Box 224
Glens Falls NY 12801
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address (I)
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
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No. Sewage alteration-2 seepage pits 8'x8' with #3 stone-2 ft depth as per `
application and specifications. Uq
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8. Proposed Use �'•.�
Sewage alteration
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 18 19 92
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 18t Day of April 19 90
SIGNED BY for the Town of Queensbury
Building and Zoning Inspecto
TOWN OF QUEENSEURY
APPLICATION FOR
Zii SEPTIC DISPOSAL PERMIT ,I1 OF:
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dab �� APR 17 1990
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DATE 1/:it J • 9°
LOCATION OF PROPERTY FOR INSTALLATION _2- ( 3 vim,,AA.,__ /-1.-------) 4_
Owner's Name: 4-Li/ T-D - 3v41T"�<-Telephone: 7 93 6 5 Sks--'
Address: ,)— 4 Diu/ti-e
Installer's Name: dJ w / -✓ t //;e4.,- � Telephone: 7 Ft) 7 S^"7
Number of bedrooms (residential only) 3
Total daily flow (compute ld 150 gal per bedroom) l7tr°
Topography: Circle one:4" Rolling Steep Slope % of Slope
Soil Nature: Circle one:a Loam Clay Other _ /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At.what depth? Feet . • _
Percolation test: Circle one: not required equired rate min. inch.
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Domestic water supply: circle one: 'Iunicipgll Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
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PROPOSED SYSTEM: Septic Tanklvw� gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench feet/Total system length • feet
SEEPAGE PIT(S): Number of 2-- / Size each p feet by feet
Size of stone to be used # --) /Depth or Thickness. 2- feet
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I have read the regulation on the reverse -••e is sheet and agree to abide by these
and all requirements of the Town of Ru-ensbu S.:nitary Sewage D pos Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: KDAA....,4- p_,04—Z---.
DATE:
OVER - '
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Septic System Inspections:
A. All applications for .septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted co the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1.) the =proposed location of the system
2.) location and distance to lot lines
. 3.) location and distance to structures •
4.) location and distance to any water supply
5.) size and dimensions of all tanks,' distribution boxes,
tile fields and/or drywells •
B. . No system shall be covered before inspection and approval by the
Building Inspector. Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up to $250.00.
C. An approved copy of the plot plan shall be_ available On the' construction
site. Failure co produce said plot. plan at time of inspection may
result in an immediate work stoppage..
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must
be submitted to the Queensbury Building Department before further
construction.
Town of Queensbury •
BUILDING and CODES' DEPARTMENT
Bay and liaviland Roads-
Queensbury, New, York 12804
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Remarks: •., •
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_Jon of iQueen96ur 1144
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
(Dueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ,f)� ".e 6°-firtA-
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LOCATION tiL / Mt1J t iAX
DATE to / 1l� PERMIT NO. (� ' ��7
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES =`NO
Percolation rate - Min/Inch - / '
1
TYPE of SYSTEM: t rW
Absorption field, to al length
Length of each trench if
Depth of trenches ,
Size of gravel
SEEPAGE P/ITS{Numbe ofi). L •
Size- &ft. X ft I 4-1,,
Gravel size 1
PIPING: , L lize Ty e
Bldg. to tank SI14X1��' L 1.,6--
Tank to dist. box / {-/ l/
Dist. box to field/ ' V _• yd(>L
Openings sealed? YES '� -NO Partial
LOCATION/SEPARATIONS:
Foundation to tan t.
Foundation to absorption j)ft.
Absorption to 194 line ft.
Separation of pits ,Oft.
LOCATION S/PEM ON PROPERTY(circle one)
Front - Rear /Left side - Right side -
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COMMENT : / / h
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SYSTEM USE APPROVED ES /NO 4
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Building Inspector
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TOWN OF 01.17.E!'4SSURN
APR 17 1990
BLDG. & CODE DEPT.
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